But there was no way for Marina and Kevin Krim to know that Ortega had begun hearing voices—and, in her family’s words, “started acting different”—back when she was 16 and still working at her father’s grocery store in the Dominican Republic.

Or that Ortega had suffered some kind of mental crisis around 2008, becoming so uncommunicative and withdrawn that her family sought to exorcise whatever was tormenting her by playing music and opening the window.

Or that she had taken a turn for the worse after bringing her 17-year-old son to New York in mid-2012, forbidding him to play baseball or listen to music and commanding him to hide under the bed with her whenever they heard a dog barking.

Or that right up to the time of the killings, she had continued hearing voices, male and female, speaking in Spanish but still unintelligible to her save for when they urged her to hurt others.

Or that she had also been having visual hallucinations of people of all colors and all sizes, “including giants,” fighting.

Or that she had felt something touch her that she thought to be the devil.

Or that three days before the killings her sister was awakened before dawn by the sound of Ortega wildly throwing pots and pans around the kitchen. The sister came in as Ortega was banging her head against the wall. The sister stayed up with her from 5 a.m. to 6 a.m., but Ortega said afterward that she did not remember anything of the incident. A psychiatrist would later testify at the fitness hearing that it was most likely a “dissociative episode.”

Or that the morning of the killings Ortega knocked on a neighbor’s door and asked if she could come in and make breakfast. The neighbor was off visiting somebody at the hospital, but a niece was there and let Ortega in. The niece became unnerved and retreated to her room as Ortega made bananas and cheese and began to pace between the living room and the kitchen. Ortega then went to the niece’s room and knocked on the door, saying, “Please come out. I can’t be alone. I’m afraid.”

The Krims knew nothing of all this, and Ortega seemed outwardly fit as she arrived at their apartment later that day. Ortega would later say she remembered making breakfast and going to work, but recalled nothing else other than she was supposed to take 6-year-old Lucia “Lulu” Krim to ballet that day.

The mother was scheduled to take her 3-year-old to swim class. She could not have been worried about Ortega’s mental state or she would not have left the nanny in charge of Lulu and 2-year-old Leo.

As with the pots-and-pans incident, Ortega said after the killings that she has no memory of what transpired. Not of Lulu and Leo being stabbed to death. Not of her suffering an apparently self-inflicted knife wound to the throat. But a psychiatrist who testified at the competency hearing was unsure whether this memory loss was the result of another “dissociative episode” or simply due to the horror of the slayings.

“It’s hard to know if it’s dissociative or she didn’t remember because of the trauma,” Dr. Karen Rosenbaum testified at the hearing on Tuesday.

Rosenbaum reported that Ortega had indicated she harbored no hard feelings toward the Krims.

“Marina was very good to me,” the psychiatrist quoted Ortega as saying.

Rosenbaum said from the witness stand in Manhattan Supreme Court that she had found Ortega mentally unfit the stand trial as a result of mental illness as well as brain damage resulting from her apparent suicide attempt. Rosenbaum contended that Ortega is incapable of appreciating her situation and assisting in her own defense.

The psychiatrist stuck to her determination when prosecutor Stuart Silberg cited a particular observation recorded by a nurse while Ortega was being treated and examined, a notation that seemed incongruous for a patient supposedly unable to integrate rational thoughts.

“Patient visible on the unit doing crossword puzzles.”

Rosenbaum allowed, “It’s possible she was attempting to do a crossword puzzle.”

Rosenbaum also acknowledged that tactile hallucinations such as having the devil touch you are so exceedingly rare as to be considered a “red flag” of possible fakery. That concern had prompted the team at the forensic jail ward at Elmhurst Hospital to administer a battery of tests. Both the psychologist who oversaw the testing and Rosenbaum concluded that Ortega was not “feigning.”

The psychologist, Julia Pearson, further joined Rosenbaum in reporting that Ortega’s mental condition had improved of late, though she continued to report hearing voices at night.

“She said she only felt sad about missing her family but otherwise felt good,” Pearson testified at the hearing.

At another point, the prosecutor asked Rosenbaum a question whose answer proved how chillingly ill Ortega remains. Silberg had already established that Ortega did remember the children’s names and was aware they had been killed.

“Did she ever say she was sad and depressed because she misses being able to see Leo and Lulu?” Silberg asked.